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_ SAN JOAQUIN COUNTY " <br /> NOTIFICATION OF HAZARDOUS WASTE 6338CHARGE APR 10 1992 <br /> HEALTH & SAFETY CODE 25180.7 ENVIRONMENTAL HEALTH <br /> PERMIT/URvi4-s <br /> A. EMERGENCY LEVEL:oil III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: eP an / 4 L- Phone: <br /> Company: <br /> Address: <br /> Phone: <br /> D i ov v6 y vG f' <br /> Designated Employee Name: r= p <br /> Reporting Agency Name: Sa 7- P Gi iJzN Nu SPry cc r�/ <br /> Address: 5- -L Tullg u <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ,i / o i F ' CA a k a. / <br /> (Best Physical Description) ( ty County) Circle One <br /> Date of Discharge: <br /> Date Notified: 3 -3/ -7.1 Time: 3 PIY9 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Lil rz // /0C, <br /> Contact Person: Grp P r --4 Telephone: <br /> Physical Address: _ 9 s s t/ F��,_ 'e',i ea i3r. Chi 9 <br /> Mailing Address: c�i of o/ E Cis u r{e r 6:�T <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume <br /> Chemicals X /rte r g2a Z <br /> Circumstances: <br /> F. ACTION TAICrN Al cv Pro (v 101;4 L41 <br /> he SP of Loy H -P - <br /> SITE DISPOSITION P14.,j < , 4- Qscrssr- a� %!/ dP .tircPss �_ <br /> lJ.e.+fnrn lite 42(, aCz � AC.-,,:�,�.7�rdY1 os i-Pc✓i�o� �v <br /> J <br /> 1 / <br /> 9fi z Nd Z- <br /> EH 22 013 (Rev.4/91) <br />